Confusion and disorientation

Individuals older than 60 years frequently develop increased sens tivity to anticholinergic drugs and require careful monitoring. Confusion and disorientation may occur. Lower doses may be required. 

Hepatic encephalopathy Change in mental or neurologic status secondary to progressive liver disease or confusion and disorientation that a patient with advanced liver disease experiences due to accumulation of ammonia. 

Adverse reactions related to more than 500 mg/day may include the following Convulsions drowsiness and somnolence headache tremor dysarthria vertigo confusion and disorientation with loss of memory psychoses, possibly with suicidal tendencies, character changes, hyperirritability, aggression paresis hyperreflexia paresthesias major and minor (localized) clonic seizures coma sudden development of CHF skin rash and elevated transaminase. 

Persons with vitamin deficiency exhibit a spectrum of nonspecific neurologic manifestations, in-ciuding depression, confusion, and disorientation, which may lead to convulsions in severe cases. 

Sedation is the most common adverse effect of metyrosine. Other CNS disturbances, such as anxiety, confusion, and disorientation, have also been reported. Symptoms of sympathetic nervous system depression in general, such as nasal congestion and dryness of mouth, can also occur. 

Molloy DW Memory loss, confusion, and disorientation in an elderly woman taking meclizine. J Am Geriatr Soc 1987 35 454-456. 

Delirium Delirium due to barbiturate withdrawal is, again, similar to that seen with abrupt alcohol withdrawal. The chief sign is one of impaired memory, of both recent and past memories. Delirium is also associated with confusion and disorientation (not knowing person, place or time). The hallucinations associated with delirium are more visual in nature and are described as terrifying. Often, patients develop a high fever. These symptoms stop by the third or fourth day, and rarely last longer than a week. 

A 27-year-old married woman developed symptoms of generalized anxiety disorder and was given buspirone 30 mg/day (32). During treatment she felt depressed and decided to take St John s wort. Two months later she started to have nervousness, aggressiveness, hyperactivity, insomnia, blurred vision, and very short periods of confusion and disorientation. The symptoms were consistent with serotonin syndrome. St John s wort was withdrawn and her symptoms resolved after 1 week. 

Loss of memory, confusion, and disorientation has been ascribed to meclozine in an 85-year-old woman (SEDA-13, 132). 

Severe hyponatremia, characterized by increasing confusion and disorientation, has been reported (SEDA-13, 83). 

Delirium and psychosis are reported with larger doses of FGAs or combinations of anticholinergics with FGAs. Chronic confusion and disorientation can occur in the elderly as aresnltof antipsychotic treatment. Unfortunately, the link is not always made between initiation of antipsychotic therapy, and the patient may be misdiagnosed with an organic mental disorder. This clinical presentation, called a pseudodementia, is easily reversible on discontinuation of the antipsychotic. 

Venlafaxine. An 85-year-old man taking venlafaxine 150 mg daily was prescribed ciprofloxacin, rifampicin and linezolid 600 mg twice daily for a hip prosthesis infection. After 20 days he was found to be confused and disorientated, and 4 days later he was also drowsy, and suffering myoclonic jerks. Linezolid and venlafaxine were stopped and the symptoms resolved over 2 days. However, another case report describes a 7-year-old boy treated with venlafaxine and methylphenidate who was prescribed linezolid for osteomyelitis. He was given all three drugs (doses not stated) for several days without any alterations in vital signs or evidence of the serotonin syndrome. ... 

A 27-year-old woman who had been taking huspirone 30 mg daily for over one month started to take St John s wort Hypericum 2000 Plus, Herb Valley, Australia) three tablets daily. After 2 months she complained of nervousness, aggression, hyperactivity, insomnia, confusion and disorientation, which was attributed to the serotonin syndrome. The St John s wort was stopped, the huspirone was increased to 50 mg daily and her symptoms resolved over a week. A 42-year-old woman who was taking fluoxetine 20 mg twice daily and huspirone 15 mg twice daily started to develop symptoms of anxiety, with episodes of over-sleeping and memory deficits. It was discovered that she had been self-medicating with St John s wort, ginkgQ biloba and melatonin. She was asked to stop the non-prescribed medication and her symptoms resolved. ... 

A 64-year-old man developed periods of confusion and disorientation within 2 weeks of starting to take lithium 300 mg twice daily with doxepin 100 mg at bedtime. He was admitted to hospital because of urinary retention, and he was also lethargic and became confused, but despite the withdrawal of both drugs he developed a condition similar to the neuroleptic malignant syndrome (fever, muscle rigidity, changes in consciousness, autonomic dysfunction), which was successfully treated with dantrolene. ... 

Further differences between HE in acute fiver failure and in cirrhosis relate to the kind of mood alterations and psycho-motor functions. In acute fiver failure irritability, insomnia and concentration deficits are followed by confusion and disorientation, and often by agitation and manic behaviour, before drowsiness occurs and the patient passes to stupor or even coma. In contrast, irritability, agitation and manic behaviour are rarely observed in HE in cirrhotics, where lethargy, psychomotor slowing and depression predominate. 

In six cases involving drivers arrested for driving under the influence who subsequently tested positive for toluene, blood toluene concentrations were 12-45 mg/1 [98 ]. All were intoxicated, and had symptoms that included balance problems, confusion and disorientation, loss of coordination, and inability to follow instructions. They also had horizontal nystagmus but not vertical nystagmus, tachycardia and raised blood pressure, and reduced body temperature. These findings are consistent with prior reports that subjects with blood toluene concentrations above 10 mg/1 have impaired driving skills. 

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